MedPageToday

Published: Jul 28, 2014 | Updated: Jul 28, 2014
By Kristina Fiore, Staff Writer, MedPage Today

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Action Points

• Note that a position statement from the American Society of Nutrition has sparked controversy due to its stance that processed foods are an integral part of the American diet.
• Be aware that the primary issue seems to be the lack of effort to distinguish minimally processed and highly processed foods.

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A new scientific statement from the American Society for Nutrition (ASN) maintains that processed foods make up an essential part of the American diet — a position that some nutrition experts have expressed concerns over, given questions over the statement’s definition of “processed.”

The statement, published in the American Journal of Clinical Nutrition (AJCN), used a definition of processing that encompassed everything from washing, packaging, and freezing foods like fruits and vegetables all the way up to adding sugars and preservatives for foods like cake mixes and frozen pizzas.

“Many staples in the diet, such as bread, cheese, and wine, bear little or no resemblance to their starting commodities and are highly processed and prepared but are often not regarded as ‘processed’ by consumers,” the authors wrote in the statement.

Many nutrition experts contacted byMedPage Today lamented the statement’s lack of distinction between minimally and highly processed foods.

“At the extreme, these are foods that all but glow in the dark,” said David Katz, MD, MPH, of Yale’s Prevention Research Center. “On the other hand, cooking, freezing, drying, and fermenting are also forms of ‘processing,’ making grilled salmon, frozen peas, dried figs, and organic plain yogurt ‘processed foods’ too. So much depends on just what we mean.”

Andy Bellatti, MS, RD, a nutritionist in Las Vegas, said it was “disappointing to see that vital information like the extent to which a food is processed is considered irrelevant by the authors. A homemade batch of hummus is literally processed, but it is light years away from a bowl of Lucky Charms. No health advocate is worried about Americans eating frozen fruit or baby carrots.”

“Given the standard American diet,” Bellatti added, “which is so high in foods that have been processed to such an extent that they offer minimal nutrition along with unhealthy oils and high amounts of added sugar, it is disappointing to see a national nutrition organization miss the opportunity to truly educate the public on why and how highly processed foods should be limited.”

Connie Weaver, PhD, head of nutrition science at Purdue University and corresponding author of the guideline, told MedPage Today that a lack of standard definitions for various levels of processed foods has “been a big part of the conflicts and issues surrounding processed foods to date.”

“We make a call in the paper that stakeholders need to work out these definitions,” she said. “Until people can talk using a common language, they end up not talking. If we can sort through the issues that turn off the dialog, then we can get to our goal of improving the health of the food supply for Americans and beyond.”

Substance of the Statement

The ASN statement used processed food definitions from the International Food Information Council (IFIC), which ranged from minimally processed (washed and packaged fruits and vegetables, roasted nuts, coffee beans) and processed to preserve peak freshness (canned tuna, frozen fruits and veggies) to foods that combine ingredients like sweeteners (instant potato mix, rice, cake mix, tomato sauce) and “ready-to-eat” foods (cereal, crackers, yogurt, cookies) and, finally, foods packaged to stay fresh and save time (deli foods and frozen pizza).

Authors of the statement relied on the 2010 Dietary Guidelines to determine relevant nutrient groups, and matched those up with NHANES data to assess nutritional contributions made by the IFIC definition of processed foods.

They found that these foods have provided a large proportion of several beneficial nutrients to the American diet: dietary fiber (55%), calcium (48%), potassium (43%), vitamin D (34%), iron (64%), folate (65%), and vitamin B12 (46%).

But they have also contributed 75% of the added sugars Americans eat, 52% of the saturated fats, and 57% of sodium.

“Although food processing has had positive impacts on human health, some of those successes have produced foods that, when consumed inappropriately or at inordinately high proportions of a total diet, are deleterious to health,” the statement says.

Based on those findings, statement authors offered advice to stakeholders in the processed food community to “enhance the contribution of processed food” to nutritional and food security. Among those is to “diminish perceived and real disadvantages of food processing.”

“Commercial food processing involves techniques that are difficult for the general public to grasp and that are out of their control, thus introducing a lack of transparency and generating suspicion and concerns about safety,” the statement said.

It also calls on food processors to develop new technologies to preserve foods in a way that increases their nutrient density while diminishing problem nutrients like saturated fats and added sugars.

Conflicts of Interest?

Several nutrition experts expressed concerns about conflicts of interest with the food industry that could have influenced the report.

Weaver said the statement was not directly supported by any food industry groups, but authors reported relationships with companies such as Nestle, ConAgra, Hershey, OceanSpray, and the Dairy Research Institute, and ASN’s supporters have included companies like McDonald’s, Monsanto, Mars, Kraft, and Kellogg.

Marion Nestle, PhD, a food policy expert at New York University, said she is an “increasingly concerned” ASN member given its relationship with industry.

“There is some — not nearly enough, in my opinion — debate within the society about whether it should be doing such things,” Nestle told MedPage Today. “The ASN is supposed to represent the interests of nutrition research. Its delving into position statements that reflect the opinions of committee members but not necessarily of the membership as a whole is a departure from previous practice.”

“Because members of the committee have financial connections with food companies,” Nestle added, “the position statement is conflicted and its conclusions come as no surprise.”

Robert Lustig, MD, a pediatric endocrinologist at the University of California San Francisco noted that the editors of AJCN appeared to distance themselves from the statement. A footnote on the first page notes that the statement didn’t go through its peer review process.

“In no way, shape, or form should this be viewed as anything but a statement from the (ASN) board of directors,” Lustig told MedPage Today. “There is not one MD among those authors. This hasn’t been vetted by an independent body.”

AJCN editor-in-chief Dennis Bier, MD, of Baylor College of Medicine, would not comment on whether all scientific statements from ASN are given this footnote when published in the journal, referring questions instead to statement authors.

“As owner [of AJCN], the [ASN] has allocated to it, as necessary, several journal pages for ‘society business,'” Bier said in an email. “The Society’s position statements fall into that category and, as such, are positions of the Society. Thus, as the footnote says, all queries about the statement should go to the Society.”

Processing Here to Stay

Despite these criticisms, nutritionists acknowledged that processed foods are a necessary part of feeding a large population.

Given a rapidly growing global population combined with the threat of global warming, the food supply may be strained in the future, Lustig said.

“Whether we like it or not, processed food is here to stay,” he told MedPage Today. “Processed food clearly extends food quantity; and with increasing population and global warming, that will be necessary. But food quality matters in terms of disease, and currently processed food misses the mark.”

Katz also noted that ‘junk’ foods may be improved to provide better nutrition, noting that consumers may have to “trade up” processed foods if fresh produce will not be able to meet demands.

“There is a rational argument here that we should do the best we can with the food supply we’ve got, and not make perfect the enemy of good,” Katz said. “But that is also a slippery slope argument, and readily devolves into food industry apologism, and the promotion of lipstick-on-a-pig food products. The Academy and its position should be judged on the clarity with which they make this critical distinction.”